Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial

Phys Ther Sport. 2019 Sep:39:90-98. doi: 10.1016/j.ptsp.2019.06.014. Epub 2019 Jul 2.


Objective: Examine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation.

Design: Randomised controlled trial.

Setting: United Kingdom National Health Service.

Participants: Twenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited. Following surgery participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM and completed 8 weeks of twice weekly unilateral leg press training on both limbs.

Main outcome measures: Perceived knee pain, muscle pain and rating of perceived exertion (RPE) were assessed using Borg's (1998) RPE and pain scales during training. Knee pain was also assessed 24 h post-training.

Results: There were no adverse events. Knee pain was lower with BFR-RT during (p < 0.05) and at 24 h post-training (p < 0.05) with BFR-RT for all sessions. Muscle pain was higher (p < 0.05) with BFR-RT compared to HL-RT during all sessions. RPE remained unchanged (p > 0.05) for both BFR-RT and HL-RT.

Conclusion: ACLR patients experienced less knee joint pain and reported similar ratings of perceived exertion during and following leg press exercise with BFR-RT compared to traditional HL-RT. BFR-RT may be more advantageous during the early phases of post-surgery ACLR rehabilitation.

Keywords: Anterior cruciate ligament; Blood flow restriction; Comfort; Pain.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Reconstruction / rehabilitation*
  • Autografts
  • Female
  • Humans
  • Male
  • Muscle, Skeletal / blood supply*
  • Pain Measurement
  • Physical Exertion
  • Regional Blood Flow
  • Resistance Training / methods*
  • State Medicine
  • Tendons / transplantation
  • United Kingdom